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Low–birth-weight infants with early-onset candidiasis have a poorer prognosis
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Extremely low–birth-weight infants with early onset of invasive candidiasis had a much poorer prognosis than those who experienced late-onset disease, according to a study published in Clinical Infectious Diseases.
“Invasive candidiasis in preterm infants is associated with serious morbidity and high mortality,” Michelle Barton, MBBS, MSc, of the Hospital for Sick Children, Toronto and the department of pediatrics at London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada, and colleagues wrote. “Within the spectrum of invasive candidiasis is a subset of infants with early onset of disease. Early onset of disease is considered to be congenital in origin and a rare entity, although the incidence is unreported.”
Barton and colleagues reviewed data from a previous multicenter study on 45 extremely low–birth-weight infants with neonatal candidiasis and 84 matched controls. All infants were aged 90 days or younger, and were enrolled from 2001 to 2003.
Fourteen of the infants (31%) had early-onset candidiasis, the researchers reported. Barton and colleagues identified three factors that were strongly associated with early onset of disease: birth weight less than 750g, gestation less than 25 weeks, vaginal delivery and chorioamnionitis. Several other conditions, such as Candida albicans infection, pneumonia, cardiovascular disease and disseminated disease, were “significantly more common” in infants with early-onset disease than in those with late-onset disease. At 71%, the early-onset group had a higher fatality rate than the late-onset (32%) and control groups (15%; P = .0001 for all). The early-onset and late-onset groups had similar rates of combined mortality and neurodevelopmental impairment (86% and 72%, respectively), but both were higher than in the control group (32%; P = .007).
“Clinicians should maintain a high index of suspicion for the early-onset variant of invasive candidiasis as the cause of early-onset neonatal sepsis in high-risk infants, that is, extremely low–birth-weight infants delivered vaginally with pneumonia and skin rash, whose mothers had an intrauterine device or clinical/histological chorioamnionitis, in addition to other previously identified risk factors for invasive candidiasis for low–birth- weight infants,” the researchers wrote. “Our data highlight this group of infants as a select group that may benefit from prompt empiric therapy.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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